2022 NLC Individual Registration Form

1Registration Selection

2Personal Information

3Demographic Information

4Terms and Conditions

6Submit Form and Go to Payment

This form is to register an individual for the National Leadership Conference, June 2-5, 2022.

If you wish to register a group of 3 or more, please use the form at this link: Group Registration

At the end of the form, you will be asked to pay via PayPal. Please have your PayPal or credit card information ready. This form cannot be saved if you leave it before paying.

Current Status *

Collegiate
National Volunteer
Lifetime Member
Conference Presenter

Please indicate your current status

Collegiate - enrolled primarily as an undergraduate or graduate professional student.
National Volunteer - circle advisors, non-collegiate members of committees, boards, or other national volunteer positions.
Conference Presenter - scheduled to present a session at the 2022 NLC
Lifetime Members - all other initiated members

Registration Type *

Late Registration - $ 199.00
Friday Only - $ 100.00
Saturday Only - $ 150.00

Volunteer Registration *

Volunteer Registration - $ 149.00

National Volunteers are those who serve as circle advisors or serve on committees, boards, or advisory groups through the National Headquarters receive the Early Registration price through April 29, 2022.

On-Campus Housing

Yes
Unsure at this time
No

Please indicate if you will want On-Campus Housing during the conference. Registrations received after May 7 will not be eligible for on-campus housing.

To view On-Campus Housing options, click here.

If you check "yes" or "unsure at this time" we will send you information about booking space on campus. If you are sure you will not stay in campus housing, select "no." If you change your mind, contact Tim Reed, tim@odk.org

Salutation/Title

Mr., Mrs., Mx., etc. (not required)

First (Given) Name *

Middle Name or Initial

Last (Family) Name *

Previous or Maiden Name

Name for Name Badge

If you'd like a nickname or other name on your name badge (Ex: Tom for Thomas or Tess for Elizabeth) please enter it here. Otherwise, we will use your listed first/given name.

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Mobile Phone *

Institution of Initiation *

Please use the full name (e.g., Washington and Lee University).

Circle Nickname

Example: Alpha Circle

Year of Initiation *

(YYYY) If you are unsure of your initiation year, please guess.

Professional/Educational Information

Professional Information

These fields are for non-collegiate members and guests only.

Industry or Professional Area *

Current Professional Title *

Current Business, Institution, or Organization Name *

Collegiate Information

These fields are for currently enrolled collegiate members (undergraduate and graduate/professional)

Major or Field of Study *

Class *

Sophomore
Junior
Senior
Graduate/Professional

Social Media

We encourage you to list your social media information so we can publish it in the EventMobi app. Only list the social media links you wish to be published.

Facebook

Instagram

Twitter

Personal Pronouns

If you would like for the NLC to use specific pronouns for your information, please complete this section.

What are your pronouns?

He/Him/His
She/Her/Hers
They/Them/Their
Ze/Zim/Zir
Prefer Not to Answer
Not listed

Do you wish the NLC to publish your pronouns with your name in the registrant listing?

Demographic Data

The information sought in this section is gathered for statistical purposes only. This information is only being used to gather data about members attending our events and will not be placed in your permanent O∆K record. An answer to each item is required but you may select "choose not to answer" for any of these items. Please note that it is helpful information to inform future discussions about the Society’s diversity, equity, and inclusivity initiatives.

For specific information on the racial and ethnic groupings in the three items below, go to DEI Demographics.

What is your age range? *

20 or under
21-24
25-34
35-44
45-54
55-64
65 or older
choose not to answer

Do you consider yourself biracial or multiracial? *

No, Not Biracial or Multiracial
Yes, Biracial
Yes, Multiracial
Choose not to anwser

Select one.

Are you of Hispanic, Latino, or Spanish origin? *

Yes, Hispanic or Latino
No, Not Hispanic or Latino
Choose not to answer

One or more may be selected.

What is your racial identity? One or more categories may be selected. *

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Not Listed
Choose not to answer

One or more categories may be selected. For specific information on these racial identity groupings, go to DEI Demographics.

What is your gender identity? *

Man
Woman
Genderqueer
Non-binary
Transgender
Non-Binary
Not Listed
Choose not to answer

Select the option that best describes you.

What is your sexual orientation? *

Heterosexual
Asexual
Bisexual
Demisexual
Gay
Lesbian
Pansexual
Not Listed
Choose not to answer

Select the option that best describes you.

Not Listed Items

If you answered "Not Listed" to any of the items above and would like to share how you identify in that area, please feel free to do so here. We will use this information to further fine-tune our options on future forms. Please include both the item and how you identify it. Thank you.

T-shirt size *

Small
Medium
Large
X-Large
2X-Large
3X-Large

The conference provides a T-shirt to all attendees. We encourage individuals to wear it at some point during the conference. Shirts are generally true to size.

Accommodations and Special Needs

We strive to host inclusive, accessible events that enable all individuals, including individuals with disabilities, to engage fully. To be respectful of those with allergies and environmental sensitivities, we ask that you please refrain from wearing strong fragrances.

Accommodation Special Needs Request

I am requesting an accommodation for the conference.

Accommodation Request

By email
By phone
By text

Please contact me in the following manner so that I may provide information about any requirements. (Check all that apply)

Dietary Restrictions or Needs

Please provide any dietary restrictions or needs so that we may plan meals accordingly. We work with the catering provider to make every effort to accommodate all needs.

Refund Policy Acknowledgement *

I agree

I have read and understood the refund policies posted on the National Leadership Conference website: NLC Registration and agree with these terms.

PHOTO RELEASE AGREEMENT *

I agree

By my registration and attendance at the 2022 National Leadership Conference, I grant to Omicron Delta Kappa, its representatives, and employees the right to take photographs of me and my property in connection with the above-identified subject.

I authorize Omicron Delta Kappa, its assigns, and transferees to use photographs or images provided by me in connection with the above-identified subject. I authorize Omicron Delta Kappa, its assigns, and transferees to copyright, use, and publish the same in print and/or electronically.

I agree that Omicron Delta Kappa may use such photographs of me with or without my name and for any lawful purpose, including for such purposes as publicity, illustration, advertising, and web content.

Total Due

$ 0.00

Payment Type *

Pay Now by Credit Card

Name